Reaching males living with HIV though scale-up of index testing services: 8 countries in sub-Saharan Africa

BACKGROUND: As part of a strategy to improve HIV case finding, programs have increasingly prioritized HIV index testing services. This shift is envisioned to improve testing access for males living with HIV. We examined index testing data from health facilities (HF) across 8 countries in sub-Saharan Africa to assess results among male and female clients.
METHODS: We analyzed quarterly, aggregate data reported for adults and children between October 2019-September 2020 by 779 HF supported by ICAP at Columbia University through the US President's Emergency Plan for AIDS Relief. This included 84 HF in Burundi, 52 in Côte d'Ivoire, 196 in Democratic Republic of Congo (DR Congo), 36 in Eswatini, 19 in Ethiopia, 1 in Kenya, 20 in South Sudan, and 371 in Zambia.
RESULTS: Overall, 68,330 clients of HIV services were offered index testing, 61% (41,553) of whom were female (Table 1). A total of 62,833 (92%) index cases accepted the services; they named an average of 2.1 contacts (132,308), a small majority of whom were male (68,551; 52%). Slightly more male (51,585, 75% of male contacts) than female (49,856, 78% of female contacts) contacts were reached and had their HIV status documented; among those eligible for testing, a slightly higher proportion of female (19%) than male (16%) contacts tested HIV+. Across countries, one HIV-positive female contact was found for every 9.1 index cases, and one HIV-positive male contact was found for every 10.2 index cases. Wide differences in these measures were observed across countries.

Table 1. Index cases and contacts, by sex, October 2019-September 2020

Country	Cases offered index testing (#, %F, %M)			Contacts identified (#, %F, %M)			% contacts with document-ed status (% of F, % of M)		% contacts known HIV+ (% of F, % of M)		Contacts with documented status newly tested HIV+ (F:#, % pos; M:#, % pos)				# cases to find 1 HIV+ F or M contact (F, M)
Burundi	4553	55%	45%	9115	54%	46%	96%	94%	4%	3%	660	14%	506	13%	6.9	9.0
Cote d''Ivoire	7166	63%	37%	11809	45%	55%	89%	90%	3%	3%	664	14%	409	7%	10.8	17.5
DR Congo	13534	58%	42%	17326	52%	48%	86%	90%	2%	1%	1924	25%	2251	30%	7.0	6.0
Eswatini	2690	65%	35%	4715	43%	57%	59%	51%	47%	35%	180	28%	189	21%	14.9	14.2
Ethiopia	1083	62%	38%	2137	44%	56%	60%	59%	9%	19%	36	7%	58	10%	30.1	18.7
Kenya	2670	62%	38%	4482	47%	53%	87%	88%	28%	33%	189	14%	148	10%	14.1	18.0
South Sudan	4394	62%	38%	7855	51%	49%	43%	41%	4%	4%	239	15%	212	14%	18.4	20.7
Zambia	32240	61%	39%	74869	47%	53%	77%	72%	29%	32%	3627	19%	2930	15%	8.9	11.0
Total	68330	61%	39%	132308	48%	52%	78%	75%	19%	21%	7519	19%	6703	16%	9.1	10.2

CONCLUSIONS: While female clients represented a substantial majority of index cases, a majority of contacts named were male. However, most contacts testing HIV+ were female, and results varied substantially by country. Further evidence is needed on index testing strategies for reaching men living with HIV.